Coverage Determinations and Appeals Call Center Requirements. The Contractor must operate a toll‑free call center with live customer service representatives available to respond to providers or Enrollees for information related to requests for coverage under Medicare or Medicaid, and Medicare and Medicaid Appeals (including requests for Medicare exceptions and prior authorizations). The Contractor is required to provide immediate access to requests for Medicare and Medicaid covered benefits and services, including Medicare coverage determinations and redeterminations, via its toll‑free call centers. The call centers must operate during normal business hours as specified in the Medicare Communications and Marketing Guidelines, and the Medicare‑Medicaid marketing guidance. The Contractor must accept requests for Medicare or Medicaid coverage, including Medicare coverage determinations /redeterminations, outside of normal business hours, but is not required to have live customer service representatives available to accept such requests outside normal business hours. Voicemail may be used outside of normal business hours provided the message: Indicates that the mailbox is secure; Lists the information that must be provided so the case can be worked (e.g., provider identification, beneficiary identification, type of request (coverage determination or Appeal), physician support for an exception request, and whether the member is making an expedited or standard request); For coverage determination calls (including exceptions requests), articulates and follows a process for resolution within twenty‑four (24) hours of call for expedited requests and seventy‑two (72) hours for standard requests; and For Appeals calls, information articulates the process information needed and provide for a resolution within seventy‑two (72) hours for expedited Appeal requests and thirty (30) calendar days for standard Appeal requests.
Coverage Determinations and Appeals Call Center Requirements. 2.10.3.1 The Contractor must operate a toll-free call center with live customer service representatives available to respond to Providers or Enrollees for information related to requests for coverage under Medicare or Medicaid, and Medicare and Medicaid Appeals (including requests for Medicare exceptions and prior authorizations). The Contractor shall provide immediate access to requests for Medicare and Medicaid covered benefits and services, including Medicare coverage determinations and redeterminations, via its toll-free call centers. The call centers must operate during normal business hours and never less than from 8:00 a.m. to 6:00 p.m. (CST), Monday through Friday. The Contractor must accept requests for Medicare or Medicaid coverage, including Medicare coverage determinations /redeterminations, outside of normal business hours, but is not required to have live customer service representatives available to accept such requests outside normal business hours. Voicemail may be used outside of normal business hours provided the message:
Coverage Determinations and Appeals Call Center Requirements. 2.12.3.1. The Contractor must operate a toll-free call center with live ESRs available to respond to Network Providers or Enrollees for information related to requests for coverage under Medicare or Medi-Cal, and Medicare and Medi-Cal appeals (including requests for Medicare exceptions and prior authorizations). The Contractor is required to provide immediate access to requests for Medicare and Medi-Cal covered benefits and services, including Medicare coverage determinations and redeterminations, via its toll-free call centers. The call centers must operate during normal business hours and never less than from 8:00 a.m. to 6:00
Coverage Determinations and Appeals Call Center Requirements. 2.10.3.1 The Contractor must operate a toll-free call center with live customer service representatives available to respond to Providers or Enrollees for information related to requests for coverage under Medicare or Medicaid, and Medicare and Medicaid Appeals (including requests for Medicare exceptions and prior authorizations). The Contractor shall provide immediate access to requests for Medicare and Medicaid covered benefits and services, including Medicare coverage determinations and redeterminations, via its toll-free call centers. The call centers must operate during normal business hours specified in the Medicare Marketing Guidelines and the Medicare-Medicaid guidance. The Contractor must accept requests for Medicare or Medicaid coverage, including Medicare coverage determinations /redeterminations, outside of normal business hours, but is not required to have live customer service representatives available to accept such requests outside normal business hours. Voicemail may be used outside of normal business hours provided the message: 2.10.3.1.1 Indicates that the mailbox is secure;
Coverage Determinations and Appeals Call Center Requirements. 2.9.3.1.The STAR+PLUS MMP must operate a toll-free call center with live customer service representatives available to respond to Providers and Enrollees for information related to requests for coverage under Medicare and Medicaid, and Medicare and Medicaid Appeals (including requests for Medicare and Medicaid exceptions and prior authorizations).
Coverage Determinations and Appeals Call Center Requirements. 2.12.3.1. The Contractor must operate a toll-free call center with live Enrollee service representatives available to respond to providers and Enrollees for information related to requests for coverage under Medicare and Medicaid, and Medicare and Medicaid appeals (including requests for Medicare and Medicaid exceptions and prior authorizations).
Coverage Determinations and Appeals Call Center Requirements. 2.12.3.1. The Contractor must operate a toll-free call center with live ESRs available to respond to Network Providers or Enrollees for information related to requests for coverage under Medicare or Medi-Cal, and Medicare and Medi-Cal appeals
Coverage Determinations and Appeals Call Center Requirements. 2.10.3.1 The Contractor must operate a toll-free call center with live customer service representatives available to respond to Providers or Enrollees for information related to requests for coverage under Medicare or Medicaid, and Medicare and Medicaid Appeals (including requests for Medicare exceptions and prior authorizations). The Contractor shall provide immediate access to requests for Medicare and Medicaid covered benefits and services, including Medicare coverage determinations and redeterminations, via its toll-free call centers. The call centers must operate the call center in accordance with the requirements of 42 CFR §§ 422.111(h)(1) and 423.128(d)(1). :
Coverage Determinations and Appeals Call Center Requirements. 2.9.3.1. The ICO must operate a toll-free call center with live enrollee service representatives available to respond to providers and Enrollees for information related to requests for coverage under Medicare and Medicaid, and Medicare and Medicaid Appeals (including requests for Medicare and Medicaid exceptions and prior authorizations).
